Trapping, dome puncture, and direct suction decompression in conjunction with assistant superficial temporal artery- middle cerebral artery bypass to clip giant internal carotid artery bifurcation aneurysm
1
Citation
30
Reference
10
Related Paper
Citation Trend
Abstract:
Very large and giant aneurysms (≥20 mm) of the internal carotid artery (ICA) bifurcation (ICAbif) are definitely rare, and optimal treatment is not established. Endovascular treatments are reported as suboptimal due to difficulties of complete occlusion and tendencies to recanalization. Therefore, direct surgery remains an effective strategy if the clipping can be performed safely and reliably, although very difficult.Two cases of ICAbif aneurysms (>20 mm) were treated. Prior assistant superficial temporal artery (STA)-middle cerebral artery (MCA) bypass was performed to avoid ischemic complications during prolonged temporary occlusion of the arteries in both cases. In Case 1 (22-mm aneurysm), the dome was inadvertently torn in applying the clip because trapping had resulted in insufficient decompression. Therefore, in Case 2 (28-mm aneurysm), almost complete trapping of the aneurysm and subsequent dome puncture was performed, and the aneurysm was totally deflated by suction from the incision. This complete aneurysm decompression allowed safe dissection and successful clipping.Trapping, deliberate aneurysm dome puncture, and suction decompression from the incision in conjunction with assistant STA-MCA bypass can achieve complete aneurysm deflation, and these techniques enable safe dissection of the aneurysm and direct clipping of the aneurysm neck. Direct clipping with this technique for very large and giant ICAbif aneurysms may be the optimal treatment choice with the acceptable outcome if endovascular treatment remains suboptimal.Keywords:
Clipping (morphology)
Superficial temporal artery
Pseudoocclusion of a superficial temporal-middle cerebral artery bypassAB Dublin and DC RicheyAudio Available | Share
Superficial temporal artery
Temporal artery
Cite
Citations (0)
Superficial temporal artery
Cite
Citations (0)
The authors present an angiographic follow-up of anastomotic surgery (extra- to intracranial) in a 33-year-old woman with moyamoya disease. The bypass was superficial-temporal to middle-cerebral, with placement of muscle tissue over the open craniotomy; the bypass eventually regressed.
Moyamoya Disease
Superficial temporal artery
Bypass surgery
Cite
Citations (25)
Moyamoya Disease
Superficial temporal artery
Middle meningeal artery
Anterior cerebral artery
Cite
Citations (4)
Superficial temporal artery
Cite
Citations (0)
Five patients treated for intracranial cerebral hemorrhage after superficial temporal artery-middle cerebral artery bypass in Xuwu Hospital, Capital Medical University, Beijing, China, from 2005-2011 were included in this study. Prior to superficial temporal artery-middle cerebral artery bypass, all patients showed diminished cerebrovascular reactivity and an ipsilateral ischemic lesion. Intracranial cerebral hemorrhage developed within 1-4 days following superficial temporal artery-middle cerebral artery bypass. Transcranial Doppler showed increased middle cerebral artery velocity of 50-100% in the operated hemisphere. These findings suggested that focal hyperperfusion, an ipsilateral ischemic lesion and diminished cerebrovascular reactivity are the important characteristics of intracerebral hemorrhage following superficial temporal artery-middle cerebral artery bypass in patients with steno-occlusive cerebrovascular disease.
Superficial temporal artery
Transcranial Doppler
Cite
Citations (1)
Superficial temporal artery-middle cerebral artery(STA-MCA)bypass surgery is a common operation in neurosurgery. There are several variations of this surgical method. We conducted a questionnaire survey on the details of surgical procedures in 171 neurosurgical institutes in Japan. Contrary to expectations, wide variations emerged in some surgical procedures, including the shape of skin and muscle incisions, the site of the temporary clip at the donor artery(STA), and the cutting method of the donor end. Western Japan institutions tended to vary more in terms of skin incision methods and donor cutting methods. It will likely be useful in the future to be aware of the numerous variations in surgical methods.
Superficial temporal artery
Cite
Citations (1)
The superficial temporal artery to middle artery bypass is a technique that allows the blood supply from the extracranial carotid circulation to be routed to the distal middle cerebral artery branches. The procedure allows blood flow to bypass proximal lesions of the intracranial vasculature. The performance of this bypass requires specialized microvascular training and the use of microvascular techniques. The techniques involved in performing these procedures include microdissection of the superficial temporal artery in the scalp, microdissection of the recipient middle cerebral artery branches near the sylvian fissure, and anastomosis techniques using either microvascular sutures or a microanastomotic device. The successful completion of the bypass and subsequent patency requires meticulous attention to technical details.
Superficial temporal artery
Microdissection
External carotid artery
Blood supply
Occipital artery
Cerebral circulation
Cite
Citations (36)
Superficial temporal artery
Middle meningeal artery
Cite
Citations (1)
Superficial temporal artery
Temporal artery
Cite
Citations (10)